Excerpt

Antibody‐mediated rejection (ABMR) is the major cause of allograft loss 1. Treatment of ABMR is difficult and resource‐intensive 3. While benefits of early detection and management of ABMR remain controversial 4, several biomarkers have been proposed to determine the status of the alloimmune response. To date, no biomarkers have been validated as isolated indicators that are independent of traditional clinical judgment 7.As a non‐invasive biomarker for graft rejection, donor‐specific antibody (DSA) has been used as important supporting evidence of ABMR to determine optimal treatment options 8. Nonetheless, only 30–40% of DSA‐positive recipients developed ABMR 9. Therefore, additional indicators, especially using renal biopsy, are needed. B‐Cell Activating Factor (BAFF; a crucial factor for B‐cell activation, differentiation, and antibody production) holds potential as one such non‐invasive biomarker due to its correlation with antibody production. Indeed, BAFF is strongly correlated with disease activity 10 and BAFF blockage attenuates disease severity 11 in lupus, an autoimmune disease with prominent antibody production.Clues to the exact role of BAFF in kidney transplantation remain limited. This study aims to explore the association between perioperative BAFF level and ABMR.